After Arizona, here’s a guide to the drugs used in lethal injections

Before the execution of Joseph R. Wood III in Arizona — an unusually drawn-out process that took nearly two hours, prompting an official review — Wood’s attorneys had argued that the lethal injection should be delayed until the state released more information about the drugs that would be used. After the Supreme Court lifted a stay of execution that was in place, Dale Baich, one of Wood’s attorneys, said that the looming execution came “with serious questions remaining about the drugs.”

This drug shortage is why Arizona used a different combination of drugs, and this drug shortage has resulted in a strange situation where different states are using different drugs for different executions, with the same states altering what they use from one execution to the next (and having the executions play out in different ways). So what drugs are being used and where? Why are they using different drugs? Here is a primer:

A standard formula and a shortage

First, some background. Until 2010, there was a fairly typical three-drug combination used for lethal injections, according to the Death Penalty Information Center. Inmates were killed utilized an anesthetic, a paralytic drug and a drug that stopped the heart. Most of the lethal injections carried out in 2009 and 2010, for example, used a three-drug combination that included the anesthetic sodium thiopental. (Ohio opted to just use sodium thiopental in an execution that year, but more on that in a moment.)

But in 2011, Hospira, the sole manufacturer of this anesthetic, announced that it would “exit the sodium thiopental market” because the Illinois-based company couldn’t guarantee it would no longer be used for a lethal injection. (Even though the company had planned to make more of the drug at a plant in Italy, Italian officials would not allow the export of the drug if it was going to be used for capital punishment.) So states turned to pentobarbital, another anesthetic,which was used in most executions from 2011 to 2013.

However, Lundbeck, the Danish company that had supplied the drug, protested its use in lethal injections. States began seeking out the drug from compounding pharmacies, but some lacked the necessary supplies of pentobarbital to keep using it. So some began using the sedative midazolam hydrochloride — and we want to emphasize the some states part. It has cropped up in less than half of the executions so far this year, while pentobarbital has been used in all of the others. (Here’s a longer look at the drug shortage and how states have responded.)

Here is a little more broken down by drug:

Pentobarbital

This anesthetic has been used in the most executions so far this year, cropping up on its own in more than half of the 26 lethal injections that have taken place. Oklahoma, Texas, Missouri and Georgia have all used it.

Oklahoma executed Michael Wilson in January using pentobarbital and two other drugs. In the first of several troubling episodes this year, Wilson’s final words, delivered seconds after the injections began, were: “I can feel my whole body burning.”

Midazolam

This drug has been used in 10 executions this year. Florida, Ohio, Oklahoma and, now, Arizona have all utilized it — and they have seen results that ranged from unusual to disturbing, according to eyewitnesses.

The Oklahoma execution, which used midazolam and two other drugs, was the most high-profile execution in the U.S. in recent memory. Clayton Lockett grimaced and clenched his teeth, witnesses said, causing the state’s Department of Corrections to halt the execution. He still died a short time later, and an initial autopsy pointed to a problem with the placement of the IV rather than the drugs.

But it wasn’t the first troubling execution involving midazolam to occur this year. In January, Ohio put Dennis McGuire to death using midazolam and hydromorphone — the same combination used in Arizona on Wednesday. This combination had not been used before in the U.S., but Ohio turned to it because of the drug shortage. It took McGuire nearly half an hour to die, and he spent part of that time gasping for air. Ohio state prison officials said in a review of the incident that McGuire did not suffer, but did say they will increase the dosage of the two drugs for future executions.

Florida wasn’t the first state to use midazolam in an execution. Last October, William Happ’s execution lasted 14 minutes; the Associated Press reported that it seemed Happ was conscious longer and moving more than other inmates killed using the earlier lethal injection formula.

Sodium thiopental

Florida used this drug in the execution of Angel Diaz in 2006, which was so unusual — it lasted for 34 minutes and required a second dose of the chemicals — that then-Gov. Jeb Bush (R) suspended executions in the state and established a commission, which found that the execution team failed to ensure proper IV access during the execution and failed to follow the state’s execution protocols.

Before the drugs, problems with veins

There have also been problems related to just finding a way to deliver the drugs. While there are no indications that this was a problem in Arizona, difficulties placing an IV in a vein was a factor in at least two mishandled executions – Clayton Lockett in Oklahoma and Angel Diaz in Florida.

This also cropped up during a 2009 execution in Ohio, when the state tried to kill Romell Broom, only to eventually halt the execution because despite repeatedly sticking him with a needle, they were unable to find a suitable vein. (He remains on death row.) It also took about 30 minutes to properly place the IV in Kenneth Biros’s arm during his execution in 2009, when he became the first person executed with a single drug (sodium thiopental) rather than a three-drug combination.

Similarly, it took the execution team in Georgia about 30 minutes to find a vein to inject Brandon Rhode the following year. The same thing has happened several times in recent years.

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